infertility in botswana

A couple of weeks ago, Rebecca Upton gave a presentation of her 15 years of medical anthropology research in Botswana regarding infertility.  She is an American researcher who was invited to speak in Gaborone by Kathleen Toomey, the current director of BOTUSA, the partnership between the Center for Disease Control and the government of Botswana.  Kathleen is friends with my grandad’s wife Diana and after hearing stories of Kathleen living in the Peruvian Amazon to do research on ethnobotany as a young woman, I have had the pleasure of getting to know her since she was offered a position to work in Botswana!  As I am learning, Kathleen has some interesting friends, Rebecca being one of them.

The first thing Kathleen told me about her was that she arrived in Botswana and went up north to the Delta and sat with women weaving baskets and talking about sex.  Now that sounded interesting.  I’ve always wanted to be an adventurer who journeys to remote areas, throws herself into awkward and challenging situations with the main pursuit of figuring out the common denominators of humans.  One of the most interesting courses I took as an undergrad was about medical anthropology, which looks at social factors in understanding human health and sickness, and so I was intrigued to meet a woman who has been in the field for quite some time.

The work of medical anthropologists is very useful when medical professionals and public health officials take into consideration actual human behavior alongside statistics in formulating solutions for individuals and large populations as a whole.  Having been here for 15 years, Rebecca was able to show us trends over time of what is important to people when it comes to mating, and how what we might see as a problem is not so in the eyes of rural Batswana.  She brought to light quite a few interesting things about infertility, relationships between men and women, and the use of condoms from her research in Botswana.  She is an abundant source of this type of knowledge, and there is a lot she presented that I do not mention here.

When Rebecca first began her research, she noted that nearly all women and men wanted children and that fertility was greatly valued.  From my experience here, it is common to find people who are one in a family of eight children or more. Rebecca wanted to know, what happens to people who can’t have children?  In a society that values children, infertility makes it difficult to find a wife or husband.  Infertility causes one to be a bit of an outcast in society because the common perception is that people are all meant to reproduce, and reproduce abundantly.  If one doesn’t use one’s ability to procreate, Batswana believe it’s a bit like leaving the calabash (gourd) on the shelf to collect dust, says Rebecca.

She told us a story of a woman who told her she had been pregnant for 14 months one time.  What came to light is that her husband had gone away, and while they had tried diligently to conceive, they were unsuccessful.  What probably happened is that while he was away, she was impregnated by another man, yet this is an acceptable explanation in the community that saves face for an infertile man, or for people whose blood doesn’t mix.

In the US we see teenage pregnancy as a problem, and for the most part, it is in our society.  Batswana would ask, “what is the problem?”  They would see a young unmarried mother, and alongside her baby, see proof that she is fertile.  This is an entirely different way of seeing teenage pregnancy and it gave me one of those enjoyable perception-flips that often come when studying anthropology.

While fertility was of utmost importance in years past, a shift has occurred from women wanting children to wanting material desires such as cash, cars, and clothes.  Women are having fewer children, as is statistically true for upwardly mobile females across many countries.  The modern woman in Botswana wants material success more so than many children, as was the case 10-15 years ago.

Rebecca also noted the openness with which HIV is discussed as opposed to years past. It is freely spoken about on the radio, in the newspapers, and in casual conversation whereas people were indignant at the mention of it on the radio during the 90s.  This is a good thing, in my mind, because talking about issues is often the way to find solutions to them, and HIV is quite a problem here.  A recent study has shown that in the age group of 15-29, nearly 50% of Botswana’s youth are infected.  However, HIV has eclipsed many other health problems, such as diabetes, and infertility, because of the amount of money and attention given to the pandemic.  There is a lot of money in HIV in sub-saharan Africa, and a lot of people who want that money.

She highlighted the use of language with respect to HIV in Botswana.  For example, there is the “fight against” HIV, but if money is pouring into the country for it, then why would people want to end that by fighting against it?  I’ve come across the use of language rife with opposition in reference to immunology during the cold war.  The human body was seen as a “battlefield” in which we were to “wage war” against bacteria and viruses through the use of synthetic medicines.  A more holistic perspective would lead one to see the body as its own defense, and suggest the use of medicines that strengthen our immune system to heal itself rather than a body that is split in two and wages war upon itself.  Indeed, during the cold war, the international power dynamic was bipolar, split between the ideology of the free market of the US and communism of the Soviet Union.  This mentality of “us vs other” and the Cartesian split was rampant among the powers that be during this era.  Hopefully we are evolving as a species and are moving towards the understanding that we are all one, and if we damage the other, we damage our self and that the solution isn’t to “fight against,” rather to “work with.”

There is a pervasive myth in Botswana and other parts of Africa that if a man has HIV he need only sleep with a virgin girl to be cured.  It is devastatingly false yet believed and practiced by many people.  However, I was surprised to hear that the same myth surrounded an epidemic of syphilis in Europe.  The disease spread rampantly because of the belief that a man would be cured by having intercourse with a virgin girl.

A popular campaign in Botswana is to promote male circumcision for the prevention of HIV.  I’ve been a bit wary of it from the beginning, and Rebecca also warned BOTUSA of the danger of seeing male-circumcision as a silver bullet for HIV prevention.  The message is unclear, and many people are misconstruing it. They are thinking that being circumcised, one can’t contract HIV, when all it does is reduce the likelihood of contraction.  Additionally, females who see a circumcised male may believe it is proof that he is HIV-negative.  You see the problem.

It was a fascinating presentation and I hope the doctors, clinical researchers, and other medical and public health professionals who attended take into account the work of medical anthropologists and the value of their data and perspectives in shaping successful interventions.

I was speaking to a friend of mine last week about HIV, and he asked me what I thought about it, and why is it such a problem with the youth in Botswana. Sechaba is a 27 year old Motswana guy, who has made an impression on me for being a particularly wise, communicative, and compassionate guy out of all I have met over the past year.  I told him I think that alcohol abuse is a big factor, because people get drunk then they don’t use good judgement or condoms.  This is a problem in the states too, but here the consequences are much more extreme.  I asked him what he thought and I was surprised to hear him say, that alcohol isn’t the problem, that it’s an attitude among men, even the sober ones.  He says that as an African male, many believe they are entitled to many girlfriends and women, and that this makes them feel masculine.  So before the problem of drinking and drugs is addressed, he thinks that a lot of healing is needed, to get to the root of the problem, which has to do with the past, and traditions in Africa with respect to masculinity.

While HIV does dominate conversations about sex and relationships, there are other issues that deserve discussion too, such as what happens when an HIV-positive couple wants to have children?  What options are there?  While not a common denominator across the board, many humans want to procreate and have a family.  In the context of a society that suffers from HIV and infertility (although not disproportionately to other countries with respect to infertility), are people discussing the options to have families without planting seeds of burden for future generations?

*the previous title was a reference to a song by beck*

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